Provider Demographics
NPI:1528232592
Name:HENRY, DONALD EUGENE
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:EUGENE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:244 EMERALD CRK W
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3351
Mailing Address - Country:US
Mailing Address - Phone:504-919-1038
Mailing Address - Fax:985-871-9293
Practice Address - Street 1:244 EMERALD CRK W
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3351
Practice Address - Country:US
Practice Address - Phone:504-919-1038
Practice Address - Fax:985-871-9293
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical